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Systemic Anti-Cancer Therapy Regimen Library

Home > GU Renal cell Metastatic - leNVAtinib and pembrolizumab Q3W [flat dosing]

GU Renal cell Metastatic - leNVAtinib and pembrolizumab Q3W [flat dosing]

Treatment Overview

Continue until disease progression or unacceptable toxicity (up to 2 years for pembrolizumab).

Cycle 1 (and all further cycles) - 21 days

Cycle length:
21

Cycle details

Cycle 1 (and all further cycles) - 21 days

Medication Dose Route Days Max Duration
leNVAtinib 20 mg Once daily oral administration 1 to 21
pembrolizumab 200 mg flat dosing intravenous 1 30 minutes
loperamide 2 mg oral administration 1
cycliZINE 50 mg Three times daily oral administration 1

Full details

Cycle 1 (and all further cycles) - 21 days

Day: 1

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.
pembrolizumab 200 mg flat dosing intravenous 30 minutes
Instructions:
Administer via a sterile, non-pyrogenic, low protein binding 0.2 to 5 micron in-line or add-on filter.
loperamide 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) at onset of loose bowel motions and a further ONE capsule (=2 mg) for every loose bowel motion (maximum of EIGHT capsules in 24 hours), or use as directed by oncologist or haematologist.
cycliZINE 50 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • Warning: may cause drowsiness.
  • Consider starting dose at 25 mg and increasing as tolerated/required.
  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.
  • Note that domperidone is not recommended in combination with leNVAtinib, olanzapine or ondansetron due to potential risk of QT prolongation.

Day: 2

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 3

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 4

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 5

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 6

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 7

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 8

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 9

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 10

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 11

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 12

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 13

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 14

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 15

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 16

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 17

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 18

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 19

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 20

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Day: 21

Medication Dose Route Max duration Details
leNVAtinib 20 mg Once daily oral administration
Instructions:
Swallow the capsules whole with a full glass of water. If unable to swallow capsules see NZF monograph for leNVAtinib or Lenvima® New Zealand Medsafe.

Supportive Care Factors

Factor Value
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment
Emetogenicity: Medium to high
Hypersensitivity / Infusion related reaction risk: Low - routine premedication not recommended

Emetogenicity: Routine antiemetic premedication may not be required for continuous dosing of oral anti-cancer medicines with MEDIUM to HIGH emetic risk; an individualised approach is appropriate.

References

Motzer R, Alekseev B, Rha SY, Porta C, Eto M, Powles T, Grünwald V, Hutson TE, Kopyltsov E, Méndez-Vidal MJ, Kozlov V, Alyasova A, Hong SH, Kapoor A, Alonso Gordoa T, Merchan JR, Winquist E, Maroto P, Goh JC, Kim M, Gurney H, Patel V, Peer A, Procopio G, Takagi T, Melichar B, Rolland F, De Giorgi U, Wong S, Bedke J, Schmidinger M, Dutcus CE, Smith AD, Dutta L, Mody K, Perini RF, Xing D, Choueiri TK; CLEAR Trial Investigators. Lenvatinib plus Pembrolizumab or Everolimus for Advanced Renal Cell Carcinoma. N Engl J Med. 2021 Apr 8;384(14):1289-1300. doi: 10.1056/NEJMoa2035716., PMID: 33616314

Merck Sharp & Dohme (New Zealand) Limited. Keytruda New Zealand Data Sheet 21 July 2022. https://www.medsafe.govt.nz/profs/Datasheet/k/Keytruda.pdf (Accessed 29 September 2022).

Eisai New Zealand Ltd. Lenvima New Zealand Data Sheet 10 May 2022 https://www.medsafe.govt.nz/profs/Datasheet/l/lenvimacap.pdf (Accessed 3 October 2022).

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.